Association Between Housing Affordability and Severe Maternal Morbidity

Abstract

ImportanceThe number of people living in unaffordable housing (relative to income) is projected to continue increasing as housing cost inflation outpaces incomes in the US. Although reproductive-aged women have disproportionately high housing costs, particularly around the time of childbirth, data on associations between housing costs and maternal health and the role of publicly supported affordable housing programs in mitigating those associations are lacking.ObjectiveTo estimate associations between area-level rental housing costs and severe maternal morbidity (SMM) and assess the potential mitigating role of publicly supported affordable housing.Design, Setting, and ParticipantsThis cross-sectional study linked New Jersey birth files from January 1, 2008, to December 31, 2018, to maternal hospital discharge records and municipal-level housing and demographic data from the state of New Jersey and the US Census Bureau. Data were analyzed from January to September 2022. The birth files contained records for all births in New Jersey, and the hospital discharge records contained information from all inpatient hospitalizations over the study period. A total of 1 004 000 birth records were matched to maternal discharge records and municipal-level data.ExposuresMunicipal-level rental costs relative to income (housing cost burden), availability of publicly supported affordable housing, and housing subsidy per person with an income lower than the federal poverty level.Main Outcomes and MeasuresSevere maternal morbidity was identified using diagnosis and procedure codes developed by the US Centers for Disease Control and Prevention to measure SMM.ResultsOf 1 004 000 mothers (mean [SD] age at birth, 29.8 [5.9] years; 44.7% White), 20 022 (2.0%) experienced SMM. Higher municipal rental housing costs were associated with greater odds of SMM (odds ratio [OR], 1.27; 95% CI, 1.01-1.60), particularly among mothers with less than a high school education (OR, 1.81; 95% CI, 1.06-3.10), and the positive associations decreased at higher levels of affordable housing availability. Among mothers with less than a high school education, the risk of SMM was 8.0% lower (risk ratio, 0.92; 95% CI, 0.85-1.00) for each additional $1000 annual municipal-level housing subsidy per person with an income lower than poverty level after controlling for rental costs and other characteristics, which translated to a 20.7% lower educational disparity in SMM.Conclusions and RelevanceIn this cross-sectional study, living in a municipality with higher rental housing costs was associated with higher odds of SMM, except when there was high availability of publicly supported affordable housing. These results suggest that greater availability of publicly supported affordable housing has the potential to mitigate the association between rental housing costs and SMM and reduce socioeconomic disparities in SMM.

Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity

“…There is abundant literature documenting potential risk factors for SMM, such as early or advanced age, lower socioeconomic status, and obesity. 29,[40][41][42][43] To provide new insights for SMM prevention, we focused on environmental risk factors that have not been examined previously. We observed that experiencing more heat days during pregnancy was associated with increased risks of SMM, where risks increased as heat exposure became more extreme.…”

“…There is abundant literature documenting potential risk factors for SMM, such as early or advanced age, lower socioeconomic status, and obesity . To provide new insights for SMM prevention, we focused on environmental risk factors that have not been examined previously.…”

In‐hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011−2019

“…Unhoused patients suffer from decreased life expectancy, 2 high morbidity and mortality, and significant barriers to receiving health care 3 . Median housing costs have risen consistently for the past 10 years, and housing instability has been linked to poor cardiovascular health 4,5 . Governmental and institutional health care support for unhoused patients in the United States varies widely by region, and significant disparities in care exist 6 .…”

“…3 Median housing costs have risen consistently for the past 10 years, and housing instability has been linked to poor cardiovascular health. 4,5 Governmental and institutional health care support for unhoused patients in the United States varies widely by region, and significant disparities in care exist. 6 The average life expectancy of unhoused patients in the United States is 54.14 years, while patients in the top 1% of earnings have a life expectancy of up to 87.3 years.…”

JAMA Network Call for Papers on Health and the 2024 US Election

“…For example, maternal mortality continues at unacceptably high rates in the US and in many low- and middle-income countries; national immigration policies that affect the health of adults have spillover effects on children’s health; US Medicaid and other nations’ policies on access to care for children affects long-term educational and employment outcomes into adulthood; policies on LGBTQ rights have implications for mental health and medical and surgical care; and firearm regulations affect outcomes in the medical, surgical, and mental health arenas across populations . The economy, always a priority for voters, has effects on mental health as well as the ability to afford health care and meet other essential needs like education, housing, sanitation, food, and water that are social drivers of health . Moreover, stagnated investments in health, health care, and health care systems worldwide portend a failure to meet health-related Sustainable Development Goals .…”